UCSD downsizes plans for proton center

Correction

This story has been changed from the original to reflect a correction in how UCSD would pay for a smaller proton project. Officials said financing options could include the UCSD Health System paying for the project with or without a mix of private partner funding.

UCSD Health said this week it is halting plans to build a $205 million proton therapy center in La Jolla that would have competed with a similar Scripps Health project that is under construction in Mira Mesa.

UCSD officials said they’ve decided, instead, to pursue a smaller $30 million project with different technology after seeing one delivered to a hospital in St. Louis in October.

With just nine proton centers operating in the United States, the decision comes amid questions about whether two proton centers can exist in one county.

Dr. Arno Mundt, chair of UCSD’s Department of Radiation Medicine, said that downsizing the university’s project was a good idea from both a financial and technological standpoint.

“We’re excited about the change in direction,” Mundt said. “The technology has been rapidly changing in the last few years and I think there are going to be a lot of simpler solutions that will be very exciting as costs go down.”

Proton therapy, approved by regulators in 2001, uses a more precise method of attacking cancer cells than conventional radiation, allowing for higher doses while limiting damage to surrounding tissue.

Leonard Arzt, executive director of the National Association for Proton Therapy, said he’s been skeptical about the viability of two nearby centers from the beginning.

“I thought getting the financing for two in the same place would be a stretch,” he said. “But there’s no shortage of patients who want proton therapy.”

The nine existing centers around the country are massive affairs. Each has a 90-ton cyclotron that accelerates protons into a beam that shoots down a long corridor into treatment rooms, each room equipped with a three-story gantry, or cylinder, with the patient’s bed inside. The gantry can rotate 360 degrees to focus the proton beam at the patient’s tumor.

Advanced Particle Therapy of Nevada is building the $185 million proton center in Mira Mesa — with Scripps Health and Scripps Clinic Medical Group as the operators and medical providers — that is due to open in 2013 and eventually treat 2,400 people a year.

The 102,000-square-foot facility will have three treatment rooms with rotating gantries and two with fixed-beam machines.

Van Gorder said Scripps would not have built its proton center if UCSD had gotten its facility off the ground.

“We’re moving into an era where we have to control health care costs and we can’t afford to duplicate services,” he said. “We need to regionalize services and look for ways to collaborate.”

Van Gorder said Scripps approached Tom Jackiewicz, former chief executive of UCSD Health, last March about collaborating on medical services at the proton center. He said Jackiewicz was interested in an ownership arrangement, which Scripps couldn’t offer since it doesn’t own the facility.

“We told them it was too late to restructure the deal,” Van Gorder said. “Could their patients be accommodated at the center? Yes.”

Mundt recalled the situation differently. He said UCSD had approached Scripps last June and been turned away.

The $30 million proton therapy center UCSD is now eyeing would use technology similar to a system delivered Oct. 31 to Barnes-Jewish Hospital in St. Louis. That system, by Massachusetts-based Mevion Medical Systems, is expected to be the first of its kind in commercial operation when it goes online later this year.

Mundt said the smaller project could be a 7,000-square-foot, one-treatment room proton center that would open by 2014 near UCSD Moores Cancer Center in La Jolla. The smaller price tag allows for more financing options, including the UCSD Health System paying for the project with or without a mix of private partner funding, he said.

“We’re shooting for a system that treats 250 to 300 patients a year,” Mundt said.

The downsizing was helped along when the investor for UCSD’s original project backed out.

UCSD had been working with a private company, Proton Health Partners of San Diego, to build the center. But UCSD didn’t renew that contract when it expired Dec. 31.

Proton Health Partners Chief Executive W. Neil Fox said the investor he had been working with, which he described only as an entity based in the United Kingdom, notified him in late October that the European debt crisis had affected its ability to invest.

But Fox said he is now in talks with a new investor. Neither of his two prospects have been worried about the prospect of two proton centers within a few miles of each other.

“The market is big enough for two centers,” Fox said.

Scripps’ Van Gorder said he wouldn’t be surprised if Fox’s European investor had dropped out because of the competition.

“There is no community in the world with two proton beam centers,” he said. “And there’s still no reason to have two in one community, even if one is downsized to a $30 million center.”

Van Gorder noted that Scripps has an agreement with Rady Children’s Hospital to provide proton therapy to pediatric cancer patients. He said the same collaborative offer still stands with UCSD.

“Our belief is the facility is sized to accommodate patients in our community and beyond,” he said.

But Van Gorder also said no one knows yet how great the demand will be. Fox said that having one proton center could put patients at risk of not getting the therapy when they need it.

“They would prefer to see cancer patients suffer if they can’t get treatment? That’s greed on their part,” Fox said of Scripps.

Arzt, of the proton association, said he thought UCSD was smart to be moving to the new, smaller technology. “That could be the future,” he said. “It could transform the proton therapy landscape and increase the number of hospitals that can have them.”

Mundt said two major players in bringing smaller systems to market are Mevion Medical Systems and ProTom International. Both systems can’t be approved by the FDA until they’re installed and tests show they perform correctly.

ProTom delivered its first compact system to McLaren Health Care in Flint, Mich., in October. McLaren is building a $40 million, three-treatment room proton therapy center that is due to open by the end of the year.

In general, the two systems are cheaper to install because the equipment produces a proton beam using a “synchrotron” that requires less radiation shielding.

Gantries also are half the size. Instead of a three-story circular apparatus that can rotate 360 degrees, C-shaped gantries are used that are 1½ stories and rotate 180 degrees, with the patient on a bed that also can be rotated.